A woman looks at a diagram of a bladder with warning signs flashing all around.

Subtle Differences Between Stage IIIB and Stage IV

I was diagnosed with bladder cancer in August 2016. I had my procedure the following month. Until the end of last year, I was under the impression that I was diagnosed at stage IV. Several professionals both at the hospital post-op and in my oncology office over the course of about 6 months told me this. I figured, "They're the professionals. They know what they're talking about." I had no reason to question this.

Sounded like stage IV

I had seen the operative report from my radical cystectomy. I knew that my tumor had been blocking my left kidney from draining correctly. Additionally, it had grown through my bladder wall and started attaching to my cervix. To my clinical lay-woman ears, that sounded like stage IV to me. No, I wasn't metastatic, but the tumor did infect other parts of my body besides the bladder.

It made complete sense to me.

Stage IV to stage IIIB

In a conversation not too long ago with my oncologist, he revealed that I was actually diagnosed at stage IIIB. I was both floored and relieved at this news. (MAN! I wish I had known that 4 years ago!)

Cancer stages

So...some of you are probably wondering, what's the difference? Well, lucky for you all, I did some research!

Bladder Cancer Stages

Stage 0Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ or CIS. CIS is not cancer, but it may become cancer.
Stages I, II, and IIICancer is present. The higher the number, the larger the cancer tumor and its ability to spread into nearby tissues.
Stage IVThe cancer has spread to distant parts of the body.

Reference: National Cancer Institute at the National Institutes of Health. Cancer Staging. March 9, 2015. https://www.cancer.gov/about-cancer/diagnosis-staging/staging. Accessed July 13, 2021.

Why is cancer staged?

When doctors stage cancer, they are determining the extent of your diagnosis. They do this for several reasons.

Staging helps doctors understand the specific sub-type of cancer you have. Yes, there are many types of bladder cancer! It also helps the doctor determine what they think your prognosis will be (also known as survival rate), what treatment options may be the best for you, and whether or not clinical trials are available to you, and if they may be effective.

Tumor, mestastatis, nodule (TMN)

Bladder cancer uses the TMN staging technique. Doctors determine where the tumor is located in the body, what the cell type is (such as adenocarcinoma or squamous cell carcinoma), the size of the tumor, and whether cancer has spread to nearby lymph nodes or different parts of the body. Tumor grade, which refers to how abnormal the cancer cells look and how likely the tumor is to grow and spread, is also examined.

The subtle difference between stage IV and stage IIIB

I did not realize that I thought that since my cancer had spread to other parts, I would be stage IV. I did not realize that stage IV was distant parts, not adjacent parts. This is why I did not question the staging when I was told initially.

The parts of my body where my cancer had spread were adjacent, next to my bladder. Therefore, I now know that I was diagnosed at Stage IIIB. Bladder cancer had NOT spread to distant parts of my body. It had NOT invaded any lymph nodes. It had NOT metastasized. I was NOT stage IV.

Understanding your stage

Now, I will freely admit that when I was told I was stage IV, I was in the midst of active treatment, had chemobrain, and was on pain meds. Is it possible that I misheard or misremembered what they told me? Absolutely! However, I have gone back and looked at notes and journal entries about this, and they also all say "stage IV." Regardless, whatever the stage I was diagnosed at, I'm beyond that now. Thankfully.

Would you like to talk to others in the bladder cancer community about staging? Reach out in our forums.

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